IHD

Question 1

is a condition in which there is an inadequate supply of blood and oxygen to a portion of the myocardium;it typically occurs when there is an imbalance between myocardial Oxygen supply and demand

Answer 1

Ischemic heart disease (IHD)

Question 2

The most common cause of myocardial ischemia that is sufficient to cause a regional reduction in myocardial blood flow and inadequate perfusion of the myocardium supplied by the involved coronary artery.

Answer 2

atherosclerotic disease of an epicardial coronary artery(or arteries)

Question 3

Genetic factors, a_____ diet,smoking, and a sedentary lifestyle are associated with the emergence ofIHD

Answer 3

high-fat and energy-rich

Question 4

are increasing and are powerful risk factors for IHD.

Answer 4

Obesity, insulin resistance, and type 2 diabetes mellitus

Question 5

The major determinants of myocardial oxygen demand(MVO2) are

Answer 5

heart rate, myocardial contractility, and myocardial wall tension (stress)

Question 6

About 75% of the total coronary resistance to flow occurs across three sets of arteries:

Answer 6

(1) large epicardial arteries (Resistance 1 = R1),
(2) prearteriolar vessels(R2)
(3) arteriolar and intramyocardial capillary vessels (R3).

Question 7

Major determinant of coronary resistance

Answer 7

prearteriolar vessels(R2)
arteriolar and intramyocardial capillary vessels (R3

Question 8

Major site of atherosclerotic disease

Answer 8

Epicardium coronary arteries

Question 9

Most critical regions causing greatest myocardial damage

Answer 9

Left main coronary artery

Proximal left anterior descending coronary artery

Question 10

What is the degree of luminal narrowing where BLOOD FLOW is reduced at rest or minimal stress

Answer 10

80% reduction

Question 11

What is the degree of luminal narrowing where there is failure to increase flow to meet increased myocardial demand (exercise and stress)

Answer 11

50% reduction

Question 12

Atherosclerotic narrowing of epicardial coronary arteries is most commonly caused by

Answer 12

ATHEROMA PLAQUE

Question 13

Metabolic consequences of ischemia:

Answer 13

1. Inability to oxidize fatty acids
2. Glucose is degraded to Lactate
   Decrease

Question 14

Factors associated with px who should receive IMMEDIATE INVASIVE (within 2hours) strategy therapy:

Answer 14

1. Refractory angina
2. Sign and symptoms of heart failure
3. New or worsening symptoms of mitral regurgitation
4. Hemodynamics instability
5. Recurrent angina or ischemia AT REST or at low level activity despite intense medical therapy
6. Sustained VTAC or Vfib

Question 15

Factors associated with px who should receive EARLY INVASIVE (within 24hours) strategy therapy:

Answer 15

Grace score of >140
Temporal change in TROPONIN
New or presumably new ST segment DEPRESSION

Question 16

Factors associated with px who should receive DELAYED INVASIVE (within 25-72hours) strategy therapy:

Answer 16

DM
Renal insufficiency EGFR<60ml/min
Ef<40 reduced LV systolic fx
Early post infarction angina
PCI within 6 months
Grace score of 109-140
TIMI score of >/=2

Question 17

CAD RISK FACTORS FOR TIMI

Answer 17

Family history of CAD
HTN
DM
Hypercholesterolemia
Tobacco use

Question 18

TIMI >2

Answer 18

Age>65
>3 CAD RISK FACTORS
Known CAD (stenosis >50%)
ASA use in the past 7 days
Severe angina (>2epi in 24hours)
ST ELEVATION >/= 0.5mm
Elevated cardiac marker level